Skin Alchemy

NEW CLIENTS

Please take a moment to complete our New Client Consultation Form. This will help us understand your needs and provide you with the best possible service. We look forward to working with you!

New Client Consultation Form

Date

YYYY

Referred by:

FULL NAME

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you pregnant?

Does your job require you to work outdoors?

What would you like to achieve today from your skincare treatment?

Have you had a facial treatment? If so, when was the last time?

Which of the following best describes your skin-type?

Do you have any special skin problems or concerns pertaining to your face or body?

Have you ever had chemical peels, laser or microdermabrasion?

Which did you receive- Chemical peel, laser, or microdermabrasion?

Do you use Retin-A, Remova, Adapalen, Hydroxyl Acid or Retinol/vitamin A derivative products?

Please describe

Have you used the above products in the last 3 months?

Please describe

Do you use acne medication?

List the name of products (toner, soap, cleanser, exfoliator, scrubs, etc) you use:

Please list:

What skin care products are you currently using? (List brand where known)

Please List:

Are you currently on Accutane?

Have you used any of the following hair removal methods in the past six weeks?

What areas of concerns do you have regarding your skin: (Please check all that apply)

Eyes

Lips

Have you ever had an allergic reaction to any of the following? (Please check all that apply and explain)

What sunscreen do you use on your face?

Have you had Botox, Restylane or Collagen injections? Please specify including date-

Any changes to or from your contraceptive treatment? If so, what and when-

Are you undergoing any hormone replacement therapy? Specify-

Please include any other information you would like to share

I acknowledge that my skin might experience temporary irritation, tightness, redness or slight swelling which usually dissipates within 72 hours depending on skin sensitivity. I acknowledge that if I am allergic to one or more ingredients in the products used, I may experience allergic reactions. I acknowledge that if I fail to use a minimal sunscreen (SPF45), I am more susceptible to sunburn, skin damage & hyperpigmentation. I should avoid excessive sun exposure especially between 10am-2pm. I acknowledge that this treatment is strictly elective cosmetic procedure and no medical claims have been expressed or implied. I acknowledge that I should avoid the use of Retin-A type products, aggressive exfoliation, waxing, and products containing acids that are no part of the recommended take-home regimen for 2-4 weeks following treatment. I consent (to the best of my knowledge) that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment. I give consent for all future treatments I release Beauty Shamanista of any liability associated with any injuries and /or current and future conditions resulting from the skincare procedures or products. (required)

Please type your full name

Photo Use Consent Form I hereby give my consent to [Your Business Name] to use photographs and/or video footage of me and/or my [service/product/event] for promotional purposes, including but not limited to, social media, website, marketing materials, and other digital platforms. I understand that these images may be used publicly, and I agree to the use of my likeness in the manner described above. I acknowledge that I will not receive compensation for the use of these images and that all rights to the images remain with [Your Business Name]. ☐ I consent to the use of my photos and/or videos. ☐ I do not consent to the use of my photos and/or videos.

PHOTOS/ VIDEO USE CONSENT FORM

Client Name

Signature for consent for media use

First Name

Last Name

Signature- "I Accept" using any device, means or action, you consent to the legally binding of this form. You further agree that your signature on this document (hereafter referred to as your E-Signature) is as valid as if you signed the document in writing.

Anti-Aging Facials

Hydro-Lift (75 MIN)- $170

Boost Collagen | Exfoliate | Lift
HYDRODERMABRASION + MICROCURRENT LED + RED LIGHT- This treatment includes a grounding breathing exercise, double-cleanse, gentle enzyme exfoliation + hydrodermabrasion, which will hydrate and plump the skin. A customized mask, a neck, shoulder, décolleté massage. Finishing the service with toner, serum, eye cream, moisturizer, face sculpt, scalp massage & lymphatic drainage, lip-balm and SPF application.
Signature Face Lift Enzyme (50 MIN) - $165

SKIN TYPE- All, Redness, Dry/Dehydrated
This 4 layer facial will change the look of your skin in just one application. 30% blend of Vitamin C , fruit enzymes and Hyaluronic Acid exfoliates, hydrates and provides antioxidants to the skin. Using vitamin C, alpha and beta hydroxyl acids, and gentle yet effective enzymes, this peel will speed up cellular turnover, lightening, tightening, and brightening your skin. Helps to reduce redness and dehydration through gentle exfoliation
Hydro-Derma Glow (75 MIN) $170

Exfoliate | Glow | Hydrate
DERMAPLANE + HYDRODERMABRASION + LED LIGHT THERAPY- The best of both worlds collide with this treatment! Includes a breath exercise for grounding, double-cleanse, dermaplane, gentle enzyme exfoliation, and moving on to hydrodermabrasion experience. A customized mask extractions (if necessary), a neck, shoulder, décolleté massage. Finishing the service with toner, serum, eye cream, moisturizer, face sculpt, scalp massage & lymphatic drainage, lip-balm and SPF application. Expect deep hydration, balanced complexion and radiant glow.

HYDRO-DERMABRASION & LYMPHATIC DRAINAGE

FACE SCULPT (50 MIN) $99

Firm | Lift | Sculpt
COLD ROLLER + BIAN STONE GUA SHA |+ SIGNATURE MANUAL FACIAL SCULPTING & LYMPHATIC DRAINAGE
Focused on facial de-puffing, defined facial features*, relaxed facial muscles, and relaxation. Expect a double cleanse, sheet mask & full focus on depuffing, sculpting, and relaxing the facial muscles. Includes: serum & SPF.
SKIN TYPE- ALL

Book Appointment
FACE SCULPT & JUST THE CROWN | (50 MIN) $165 | (75 MIN) $250

Depuff | Lymphatic Drainage | Scalp Health
Focused on facial de-puffing, defined facial features*, relaxed facial muscles, and relaxation. Expect a double cleanse, sheet mask & full focus on depuffing, sculpting, and relaxing the facial muscles PLUS a scalp oil treatment/massage. Enjoy rosemary water spritzed onto the scalp and hair followed by a steam treatment. Followed by a soothing scalp brushing and scalp massage finishing with a soothing scalp oil treatment and leave-in hair mask. Service includes subtle energy work throughout the service, crystals, sound healing, and ends with a meditation. Includes: serum & SPF.
NOTE- This is a no washing service. Please come with clean hair/scalp.
SKIN TYPE- ALL

Book Appointment
HYDRO-GLOW (50 MIN) $140 | (75 MIN) $180

Boost | Glow | Hydrate
HYDRODERMABRASION - This treatment includes a grounding breathing exercise, double cleanse, hydro-dermabrasion, extractions (if necessary), gentle enzyme exfoliation, customized mask, as well as a luxurious neck, shoulder, décolleté, PLUS a stimulating face massage and a scalp massage. Finishing with toner, oxygen serum, eye cream, moisturizer, lip -balm and SPF application. Expect deep hydration, balanced complexion and radiant glow.
SKIN TYPE- ALL

Book Appointment
HYDRO DERMA-GLOW (75 MIN) $170 (90 MIN) $250

Exfoliate | Glow | Hydrate
DERMAPLANE + HYDRODERMABRASION + RED LIGHT-
The best of both worlds collide with this treatment! Includes a breath exercise for grounding, double-cleanse, dermaplane, gentle enzyme exfoliation, and moving on to hydrodermabrasion experience. A customized mask extractions (if necessary), a neck, shoulder, décolleté massage. Finishing the service with toner, serum, eye cream, moisturizer, face sculpt, scalp massage & lymphatic drainage, lip-balm and SPF application. Expect deep hydration, balanced complexion and radiant glow.

Book Appointment

CHEMICAL PEELS & OXYGEN THERAPY

SIGNATURE FACELIFT ENZYME (60 MIN) $165

SKIN TYPE- All, Redness, Dry/Dehydrated
This 4 layer facial will change the look of your skin in just one application. 30% blend of Vitamin C , fruit enzymes and Hyaluronic Acid exfoliates, hydrates and provides antioxidants to the skin. Using vitamin C, alpha and beta hydroxyl acids, and gentle yet effective enzymes, this peel will speed up cellular turnover, lightening, tightening, and brightening your skin. Helps to reduce redness and dehydration through gentle exfoliation
OXYGEN LIFT PEEL (50 MIN) $150

SKIN CONCERN/TYPE- Dull skin, dry/dehydrated
A luxurious treatment infuses oxygen, plant-derived stem cells, peptides and a high concentration of enzymatic botanicals into the skin leaving it luminous, refreshed and rejuvenated. This is known as,”The Red Carpet” facial.
LIGHTENING LIFT PEEL (50 MIN) $155

SKIN TYPE- Pigmentation, photo damage, sun/dark spots, and melasma
Powerful AHA in an organic aloe vera gel base targets and corrects all forms of pigmentation to leave skin even toned and illuminated.
LET'S GET CHEEKY (LIGHTENING TREATMENT TARGETING THE BUM) $115

This lactic acid treatment is for inner thighs and/or buttocks. Targeting hyperpigmentation to help lighten, brighten and promote healthy glowing skin. The skin’s natural moisture will increase and the overall structure of the skin will be strengthened.